Urethral Stricture – Symptoms, Causes and Treatment

Urethral stricture occurs when scarring narrows the tube that carries urine out of your body (urethra), preventing the flow of urine through it freely. This medical condition occurs more commonly in men.

What is Urethral Stricture?

The urethra is a duct or passageway present in both males and females and allows urine to pass outside the body. The length of the urethra is much longer in men due to differences in anatomy. 

It also serves as a channel for the ejaculation of semen during sexual activity for men. It extends approximately 20 cm across the length of the penis. On the other hand, the urethra is only 4 cm long in women.

Symptoms of Urethral Stricture

There can be numerous symptoms of a stricture, ranging in severity,. They are as follows: 

• A reduction in urine flow
• Experiencing burning or pain during urination
• Sudden urges to urinate
• Incontinence (inability to control urinating)
• Pain in the lower abdominal area
• Darkening of urine
• Blood in urine or semen
• Penile swelling (in men)

Another effect could be the inability to urinate. It is a severe condition and requires immediate medical attention.

What Can Cause a Stricture to the Urethral Area?

The narrowing or scarring of the urethra is generally caused by:

• Trauma from a past accident or injury that resulted in damage to the bladder or urethra
• Pelvic injuries (a fracture of the pelvic bones)
• Placement of instruments such as catheters during surgical procedures
• Radiation

Other causes include untreated UTIs (urinary tract infections), sexually transmitted diseases or STDs such as gonorrhea or chlamydia, and a tumor near the urethral area. It can happen to young boys undergoing hypospadias surgery (a surgical procedure used to correct an underdeveloped urethra). Men who have a large prostate or choose to get penile implants can also develop this condition. A straddle injury is another type of trauma that can cause such strictures.

How is Urethral Stricture Diagnosed?

Doctors who treat urinary tract diseases in both men and women are called Urologists. A diagnosis is conducted based on previous disease history, physical examinations, and studies that help determine the precise location and extent of the stricture.

A simple physical examination of the penile area can allow the doctor to observe any redness or swelling that might be present.

One of the most direct ways to check for stricture is cystoscopy. A small tube attached to a camera is inserted to examine the insides of the bladder and the urethra. Urethral imaging (using X-rays or ultrasound) is another useful diagnostic tool. 

When to see a doctor

If you experience any of the symptoms or get subjected to one of the causes mentioned above, which can lead to a stricture, reach out to a medical professional immediately.

Request an appointment at Apollo Hospitals

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What are the Various Treatment Options?

Like any other medical issue, ascertaining the best course of treatment depends on how severe the condition is. There are many surgical and non-surgical options available. They are as follows:

Non-surgical Option

• Dilation: Large dilators called “sounds” may be used to stretch the narrowed stricture. A special balloon placed on a catheter can also help with the stretching of the tissue. However, this stretching is not a permanent solution and needs to get performed regularly. In cases where the stricture comes back too often, a urologist will train you to insert the catheter yourself from time to time. Bleeding and infection are possible side effects. Sometimes, even a false passage or second urethral passageway may form as a result of the stretching.

Surgical Options

• Urethrotomy: A d scope is moved along the length of the urethra until the stricture is found. A laser or knife blade at the end of the scope creates a gap in the stricture. Sometimes, a catheter might be placed in the opening to keep it open and allow it to heal.
• Open surgery: There are two main options of reconstructive procedures (procedures to treat defects caused at birth) used to cure strictures. This surgery is the gold standard option as it has long-term success rates compared to other options. They are:   
  • Anastomotic Urethroplasty: This procedure usually is performed for strictures that are not very long. For short strictures which involves bulbar urethra (a bulb shaped part of urethra that lies between the scrotum and the prostate), a segment of scarred urethra can be removed completely. The two cut ends of the urethra are sewn together. A catheter is placed in the penis for 10-21 days, which is removed later when X-rays show that the area is healed.
  • Substitution Urethroplasty: Tissues are transplanted to act as a replacement for the stricture area if the stricture is too long. In some cases, this substitution may happen in stages. The types of substitution procedures are:
    • Grafts: As graft does not have its own blood supply, it depends on the blood supply of host, where it was transferred, to survive. 

In this method, your body tissue is used to replace or expand a portion of the urethra. This tissue is  taken from the inside of a cheek or the penis shaft. Post-surgery, the use of a catheter may be prescribed for 2-3 weeks.

• Skin Flaps: Transfer of the tissue from one body part to another, where the donor blood supply is left intact is called a flap. The penile flap urethroplasty makes use of the penil skin flap to reconstruct a urethral stricture . It is needed when the graft required to be long.

Risks of Surgical Options

After any surgery of the urinary tract, one can expect blood in the urine for some time. Bladder discomfort and UTIs are additional risks.

Post-treatment

Urethral strictures generally reappear after surgery. Hence, it is vital to visit your urologist for follow-ups. In some cases, the stricture may come back, and it needs to be looked at by a specialist.

Conclusion

While a urethral stricture can be hard to diagnose, you can self-report any symptoms you experience for immediate treatment and take active steps for its prevention.

Frequently Asked Questions (FAQs):

Why do men have a higher risk for urethral strictures?

Urethral strictures rarely occur in women and infants, as men have the longer  urethra. Additionally, men who have had more than one urinary tract infection, urethritis (swelling and irritation of the urethra), and an enlarged prostate are also at a higher risk for urethral strictures.

What are some complications from urethral stricture?

UTIs can be both a cause and a complication that arise from urethral strictures. The occurrence of bladder stones is another problem that manifests when the bladder does not empty after urination. If left untreated, urethral strictures can also cause enlarged bladder and other kidney problems.

What are some preventative measures one can take?

The most important preventive measure would be to avoid injury to the pelvic and urethral areas. Self-catheterization should only get performed after consulting a medical expert. Sexually transmitted diseases (STDs) can be avoided by using protection during sexual activity.